Interviewers

The FFQ, originally developed for the TLGS, was a Willett-format questionnaire modified based on Iranian food items²⁵ and contains questions about average consumption and frequency for 168 food items during the past year.⁷ The food items were chosen according to the most frequently consumed items in the national food consumption survey in Iran.²⁵ Because different recipes are used for food preparation, the FFQ was based on food items rather than dishes, eg, beans, different meats and oils, and rice. Subjects indicated their food consumption frequencies on a daily basis (eg, for bread), weekly basis (eg, for rice and meat), monthly basis (eg, for fish), yearly basis (eg, for organ meats), or a never/seldom basis according to portion sizes that were provided in the FFQ. For each food item on the FFQ, a portion size was specified using USDA serving sizes (eg, bread, 1 slice; apple, 1 medium; dairy, 1 cup) whenever possible; if this was not possible, household measures (eg, beans, 1 tablespoon; chicken meat, 1 leg, breast, or wing; rice, 1 large, medium, or small plate) were chosen. Table 1shows food items and portion sizes used in the FFQ. Trained dietary interviewers with at least 3 of experience in the Nationwide Food Consumption Survey project²⁵ or TLGS^{26 (link)} administered the FFQs and 24-hour DRs during face-to-face interviews. The interviewer read out the food items on the FFQ, and recorded their serving size and frequency. The interview session took about 45 minutes. The interviewer for FFQ1 and FFQ2 was the same for each participant. Daily intakes of each food item were determined based on the consumption frequency multiplied by the portion size or household measure for each food item.²⁷ The weight of seasonal foods, like some fruits, was estimated according to the number of seasons when each food was available.
Dietary data were also collected monthly by means of twelve 24-hour DRs that lasted for 20 minutes on average. For all subjects, 2 formal weekend day (Thursday and Friday in Iran) and 10 weekdays were recalled. All recall interviews were performed at subjects’ homes to better estimate the commonly used household measures and to limit the number of missing subjects. Detailed information about food preparation methods and recipe ingredients were considered by interviewers. To prevent subjects from intentionally altering their regular diets, participants were informed of the recall meetings with dietitians during the evening before the interview. All recalls were checked by investigators, and ambiguities were resolved with the subjects. Mixed dishes in 24-hour DRs were converted into their ingredients according to the subjects’ report on the amount of the food item consumed, thus taking into account variations in meal preparation recipes. For instance, broth or soup ingredients—usually vegetables (carrot or green beans), noodles, barley, etc.—differed according to subjects’ meal preparation. Because the only available Iranian food composition table (FCT)²⁸ analyzes a very limited number of raw food items and nutrients, we used the USDA FCT²⁹ as the main FCT; the Iranian FCT was used as an alternative for traditional Iranian food items, like kashk, which are not included in the USDA FCT.
The food items on the FFQ and DR were grouped according to their nutrient contents, based on other studies,^{30 (link)} and modified according to our dietary patterns. Seventeen food groups were thus obtained, as follows: 1) whole grains, 2) refined grains, 3) potatoes, 4) dairy products, 5) vegetables, 6) fruits, 7) legumes, 8) meats, 9) nuts and seeds, 10) solid fat, 11) liquid oil, 12) tea and coffee, 13) salty snacks, 14) simple sugars, 15) honey and jams, 16) soft drinks, and 17) desserts and snacks (Table 1). The 168 food items on the FFQ were allocated to these 17 food groups, and the amounts in grams of each item were summed to obtain the daily intake of each food group.

We conducted key informant interviews with 28 respondents in the three refugee hosting districts. A semi-structured interview guide with open-ended questions and focused probes was used to guide the interviews. The guide consisted of several themes including: (a) elements of health services, (b) organisational factors on sustainability of health services (c) community and ecological factors and (d) funding. The questions emerged from literature review and the framework for sustainability of health services adopted to humanitarian health assistance. Interviews were conducted by trained research assistants. Interviews were conducted in English. Each interview lasted approximately between one to one and half hours. All interviews were audio-recorded with notes taken by interviewers.

Firstly, before every interview, the respondents were made aware of the importance of their answers. The questionnaire was also designed to verify past responses with the following questions. In addition, interviewers were trained to detect incorrect answers by returning to some of the answers previously given by respondents and repeating some questions. This technique resulted in satisfactory responses from the mothers. However, after data collection, the forms were sorted to eliminate incorrect responses, poorly filled-out forms, and wrong answers.

This paper draws on interview-based research conducted from May to June 2022, as part of a broader project investigating how information about medicines moves between patients, pharmacists, and general practitioners. To explore how GP’s approached prescribing decisions and understood their relationships with patients and pharmacists around medicines, we elected to use an interview methodology. Interview methodologies are well-suited to research that investigates people’s thoughts and experiences, and the semi-structured format accommodates emergent findings that might not be anticipated in the original research design. The project received ethics approval from the Victoria University of Wellington Human Ethics Committee (#28324).
Given our aim to solicit general practitioners’ views specifically, we followed a purposive sampling strategy and recruited from a national pool, so as to gain cross-sectional insights from different geographic, socioeconomic, and institutional settings. Using the Medidata database of general practitioners, we issued an invitation for interview participants that reached 1,331 recipients. Of these, 25 people registered their interest via the supplied link, and 16 followed through to an interview. Our only selection criterion was that participants must be currently practicing general practitioners, as all 25 initial respondents were. Recruitment stopped when participants stopped opting in to the study.
While most of our resulting sample worked full-time in general practice, some of our interviewees worked part-time, as locums, or combined their general practice work with, e.g., working for hospice. Of our sixteen participants, 10 were female and six male. Eight were based in one of New Zealand’s three major cities, six in a smaller city or large town, and two rurally. Thus, while our sample is not representative, it does encompass a range of professional and regional experiences and clear themes were evident across the data set.
Interview guides were developed from the overall project’s aims, and included questions about participants’ professional backgrounds and contexts, prescribing practices and views on medicines, relationships to pharmacists, and perspectives on the New Zealand health system. In keeping with the semi-structured interview process, we allowed these guides to steer our conversations without dictating or unnecessarily limiting their course. The interview procedure was not adjusted in light of emergent findings, so as to ensure maximum comparability across the data set. However, the interview guide was adapted in some cases to suit individual participants’ time availability.
The authors conducted all interviews via Zoom, between May 1 and June 30 2022. Interviews lasted from 24 to 68 min, with a mean duration of 46 min 30 s. Typically, shorter interviews were those conducted during participants’ lunch breaks, and longer ones were conducted on participants’ days off or in the evenings. All interviews were audio recorded using the computer’s inbuilt recording software, then professionally transcribed verbatim. The original audio files and resulting transcripts were allocated pseudonymised alphanumeric file names (linked to identifying information in one securely stored spreadsheet) and stored in the University’s secure cloud storage system.
Although Denise Taylor training as a pharmacist could potentially be expected to influence how interviewees spoke about the pharmacists they interacted with, we did not note any discernible differences in the results collected by each interviewer, and neither had any existing relationship with any participants. It is possible that conducting interviews via Zoom also mitigated the extent to which the researchers’ positionality shaped interviews. We were known to participants’ primarily by our qualifications, professional roles, and association with a respected funder, with few cues as to our respective physical presentations beyond the shoulders-up Zoom window.
Our data analysis was conducted by (Courtney Addison) June through October 2023, and checked and discussed with Denise Taylor. Our analytic process was grounded in the constructivist tradition of Corbin and Strauss [34 ], which acknowledges the role of the analyst in meaning-making, and followed a Reflexive Thematic Analysis process [35 (link)]. This began with familiarisation with the data set (all interview transcripts), followed by iterative, open coding of the corpus. Codes were then reviewed and grouped into themes, which were themselves reviewed against the transcripts. The review process enabled refinements to the theme, so that, for example, the theme ‘Doctor/pharmacist interactions’ became ‘Sharing information about patients’, ‘Seeking medicines information’, ‘Correcting mistakes’. To check the validity of findings, the authors discussed transcripts and codes from their distinct disciplinary perspectives (Anthropology and Pharmacy, respectively) and also compared findings against the data set from the other arm of this project, which consists of interviews and observations from a community pharmacy. This confirmed, for example, that doctors were using pharmacists in the ways they described in the interviews reported on here, and that pharmacists were indeed picking up mistakes as interviewees report.